Capecitabine (Xeloda): side effects and what to do

Slightly raised temperature

A slightly raised temperature, otherwise well.

Fever: always an emergency during chemotherapy

A temperature of 38.0°C (100.4°F) or more, even once. Or shivering, chills, or feeling suddenly very unwell.

• Keep a thermometer at home. Check your temperature whenever you feel unwell, hot, cold or shivery.
• Do not take paracetamol before checking: it can hide a fever.
• Wash hands often; avoid crowds and people with colds, cough or chickenpox.
• Eat freshly cooked food; avoid raw salads, cut fruit and street food when counts are low.
• Brush gently, keep cuts clean, and do not squeeze pimples.

• Growth factor injections (G-CSF) may be given after chemotherapy to raise white cells.
• Antibiotics are given by us when needed. Do not start antibiotics from home without telling us.

Mild (grade 1)

Feeling sick and eating a little less than usual, no vomiting.

Moderate (grade 2)

Eating much less than usual, or vomiting 1 to 3 times in a day.

Severe (grade 3 or 4)

Vomiting more than 3 times in 24 hours, or cannot keep down water or medicines, or feeling dizzy.

• Take your anti-sickness tablets on time for the days advised, even if you feel well.
• Eat small, plain meals often: idli, toast, rice, biscuits. Avoid oily, spicy food and strong smells.
• Sip fluids through the day: water, ORS, lemon water, coconut water.
• Ginger tea or lemon may help.
• Sit up for 30 minutes after eating.

• Ondansetron or granisetron, aprepitant, dexamethasone, olanzapine and metoclopramide.
• If you still feel sick, tell us: the medicines can be changed or added for the next cycle.

Mild (grade 1)

1 loose stool more than usual in a day, otherwise well.

Moderate (grade 2)

2 to 3 loose stools in a day, or tummy cramps.

Severe (grade 3 or 4)

4 or more loose stools in 24 hours, or any loose stools with blood, fever, or dizziness.

• Drink plenty: ORS, buttermilk, rice water, coconut water, clear soups.
• Eat soft, low-fibre food: curd rice, idli, khichdi, banana, toast.
• Avoid milk, oily and spicy food, raw salads and fruit juices until better.
• Keep the skin around the bottom clean and dry.

• Loperamide, as advised by your doctor. Do not take it if you have fever or blood in the stools, without asking us.
• On immunotherapy, loose stools may need steroids: always tell us.

Mild (grade 1)

Soreness or redness; eating normally.

Moderate (grade 2)

Painful ulcers; you can eat soft food only.

Severe (grade 3 or 4)

Cannot eat or drink, or cannot swallow saliva.

• Rinse 4 to 6 times a day with salt water or soda bicarbonate water (half a teaspoon in a glass of water).
• Use a soft toothbrush; avoid alcohol-based mouthwash.
• Eat soft, cool, mild food: curd rice, dal, khichdi, ice cream. Avoid spicy, sour and very hot food.
• Keep lips moist.

• Pain-relieving gels and mouthwashes; antifungal medicine if there are white patches (thrush).

Mild (grade 1)

Tired, but better with rest.

Moderate (grade 2)

Not better with rest; you cannot do housework, shopping or work as usual.

Severe (grade 3 or 4)

Cannot get out of bed or walk, fainting, dizziness on standing, or tiredness with breathlessness or confusion.

• Gentle exercise, such as a 20 to 30 minute walk most days, helps more than resting all day.
• Plan important things for your better days; accept help with chores.
• Short naps (under 30 minutes), regular sleep times.
• Eat well and drink enough.

• Treating the cause: a blood transfusion or iron for low haemoglobin, thyroid tablets, or help with sleep or low mood.

Mild (grade 1)

Dry skin, mild rash or redness, without pain.

Moderate (grade 2)

Painful redness or peeling of the hands or feet, or a rash over a large area, that affects daily work.

Severe (grade 3 or 4)

Blisters, skin peeling off, a rash with fever, a rash in the mouth or eyes, or a red, hot, swollen area with pus.

• Moisturise twice a day with a fragrance-free cream; urea cream for hands and feet.
• Use sunscreen and cover up in the sun.
• Bathe with lukewarm water and mild soap.
• Avoid tight shoes, hot water and long walks if hands and feet are sore.
• Keep nails short; wear gloves for housework.

• Antibiotic tablets and creams for EGFR rash; steroid creams; a short break or dose change for sore hands and feet.